Don’t let the carers of today become the patients of tomorrow

In his latest blog post Dr Hein Le Roux reflects on the danger of making assumptions and how to turn negative experiences into positive ones.

Carers play a crucial role in our society and it is important that they continue to be recognised and valued.

Practice colleagues at Minchinhampton Surgery have been working on a quality improvement (QI) project which builds on the great work many practices are already doing to better identify carers, raise their profile and signpost them to carer support organisations such as Carers Gloucestershire.

The project came about when a carer (John) approached our practice manager (Wendy) to tell us that he felt there were gaps in how our practice dealt with him, and by inference the other 200 carers on our register.

Wendy had the foresight to turn John’s negative experience into something very positive both for all the carers registered at our practice as well as our practice team, and John agreed to work with us as an equal partner (Patients as partners – Kings Fund) to improve on a quality improvement project.

As a practice, we realised that it can be easy to become defensive, assuming that patients always want a Rolls Royce. However, by listening, we realised that often all they want is a bicycle that works.

By listening to John, we were able to better understand his frustrations. Surprisingly, despite being a full time carer to his wife, he had never heard of Carers Gloucestershire. As a practice, we realised that it can be easy to become defensive, assuming that patients always want a Rolls Royce. However, by listening, we realised that often all they want is a bicycle that works. In other words, simple improvements can really make a big difference to people’s lives.

We contacted Carers Gloucestershire who shared their best practice guide for GP practices. They suggested that we approach Locking Hill Practice, which is seen as a beacon carer practice, having previously worked with Carers Gloucestershire and their PPG to develop a highly regarded Carers scheme.

Their practice manager (Jenny Valleley) was inspirational and happy to share their experience, learning and documents with us. In a world where there can be both implicit and explicit competition between us all, this collaborative and open approach was really refreshing and made a tangible difference to patient care. Instead of reinventing the wheel, we have then adapted their resources to inform our own local project that is bespoke to our situation.

The project has led to four specific actions being taken at Minchinhampton surgery, which other practices may find useful:

  • A member of staff has been appointed as Carer Administrative Lead.
  • In collaboration with John and the local PPG, the practice has developed a carers pack containing useful information, including details about Carers Gloucestershire. This is given to existing and new carers registering at the practice. We measure how many packs we give out to track our progress.
  • The practice has built a good relationship with the local PPG, gaining their support in raising the profile of carers in the local community, many of whom are socially isolated and lonely. Some of our PPG members are also carers, so this project resonates with them and we have certainly valued their interest and contribution.
  • A practice learning event was held – John and Carers Gloucestershire spoke about what it means to be a carer and what practical help practice teams could offer to support.  Like your teams, our practice team is already very empathetic to our patients and having this learning event has enabled us to combine their intrinsic kindness with new practical skills to help improve our carers wellbeing.

The links below may be of interest for improving your carers’ experiences. We are very open to your feedback and are always keen to improve what we do.

  1. Carers in Gloucestershire (Tim Poole, Chief Executive of Carers Gloucestershire)
  2. A Carer’s Perspective (John)
  3. A Carer’s Perspective (Gerald)
  4. Carer Project (Jenny Vallely, Practice Manager at Locking Hill)
  5. Supporting Carers (Kerry Renowden)
  6. King’s Fund paper on ‘Patients as Partners’
  7. Quality improvement resource

Patient Safety Collaboratives: heartening, ambitious and innovative

What do you get when you cross an urgent care system under tremendous pressure with a newly formed Patient Safety Collaborative looking for a flagship project? asks Managing Director Deborah Evans ahead of our session at Patient First on 22 November.

Against all expectations, we found that our proposition to embed the National Early Warning Score  (NEWS) across the entire urgent care system in the West of England has captured the imagination of clinicians in primary care, acute hospitals, mental health, community services and the ambulance service.

Our clinical director Anne Pullyblank showed a short film at one of our conferences and a few months later 130 people turned up at an engagement event.  The very next day, we started getting phone calls from clinical teams saying they were starting to use NEWS in areas that had never used it before.

We have been living with the consequences ever since. How do you get a good baseline when blessed with clinicians who Just Do It? How do you set a measurement strategy for whole system change? How do you attribute causes when so much is being changed right across the urgent care system all the time?

Our NEWS journey will be the subject of our session in the Best Practice Theatre at Patient First later this month, “The deteriorating patient – what about Bobby?” which will highlight the huge potential NEWS has when used across the entire system at every handover of care.

We’re now 18 months into this journey and have been reflecting a great deal about the role that Patient Safety Collaboratives can play.

We are one of 15 Academic Health Science Networks, comprising the AHSN Network which covers the whole geography of England. Each AHSN coordinates the Patient Safety Collaborative covering the same patch.

The AHSN model of a network of member organisations gives us a strong basis for engagement and grassroots support. We thrive where clinicians and their organisations commit their discretionary effort. We have a system wide perspective because we include CCGs, NHS trusts and other providers of health care, and can draw in statutory and non-statutory partners. We are independent and are seen as such; we are not part of the performance management system experienced by so many. We work in partnership with Sign Up to Safety, the Health Foundation, NHS Improvement and many, many others.

In a landscape of overlaps and gaps we are giving many clinicians an opportunity to work together, rather than in competition.

Patient Safety Collaboratives are now in their third year of operation and all over the country there are heartening, ambitious and innovative projects in play.

We share and learn together and have developed a ‘logic model’ to provide a conceptual framework. We build capability with our member organisations and have developed a software platform ( Seedata Life system) which is already the repository for hundreds of quality improvement (QI) projects – offering all the tools to run QI work and share the learning.

Already we have some ambitious and large scale programmes. The Emergency Laparotomy Collaborative is a shared project across 25 acute hospitals in the West of England, Kent, Surrey and Sussex, and Wessex – we are improving the quality of care together and using a shared national set of metrics to review and learn. The South of England Mental Health Collaborative embraces 16 mental health trusts and offers inspiring learning sets on an ‘all share, all learn’ basis. This is parity for mental health services beginning to move from words to commitment.

We will have a strong presence at this year’s Patient First. Visit our Patient Safety stand to find out more about us and our work. Talk to people from your area. Make connections. Attend our Best Practice Theatre. Feel the energy.

The West of England AHSN’s performance of “The deteriorating patient – what about Bobby?” will take place on Tuesday 22 November at 14:30 in the Best Practice Theatre at Patient First.

Download the full programme here and register for a fully-subsidised place at using the code AHSN46.